Meeting Minutes Meeting: Long-Term Care Council Date: Wednesday, November 30, 2016 Start & End Time: 10:00 a.m. to 3:00 p.m. Location: Pennsylvania Department of Aging, Conference Rooms A, B & C

Council Members in Attendance Joan Bradbury Lydia Hernández-Vélez Sec. of Health Karen Murphy (Designee: Lori Howe-Gutierrez)* Sen. Brian Hudson, Sr. Dr. David Nace (Designee: Chloe Zittle, Esq.)* (Designee: Gelene Nason)* Brig. Gen. Anthony Carrelli Kathleen Kleinmann Shane Nugent (Designee: Maj. Gen. (R) Eric Weller)* Dr. Mario Cornacchione Commissioner Ted Kopas Sec. of Aging Teresa Osborne Council Chair Tim Coughlin John Kordish Vini Portzline

Sec. of Human Services Ted Dallas Ray Landis Kenneth Potter, Esq. (Designee: Dep. Sec. Jennifer Burnett)* Representative Pam DeLissio Thomas Lilly, JD, CLU Nicole Pruitt

Lynn Fields Harris Robert Marino Sec. of Transp. Leslie Richards (Designee: Emma Lowe)* Sen. Art Haywood Joyce McClary Mike Sokoloski (Designee: Liana Walters, Esq.)* Rep. Diane Menio Matt Yarnell (Designee: Erin Raub)*

Anne Henry Insurance Comm. Teresa Miller Heshie Zinman (Designee: Jessica Altman)* *Attended on member’s behalf

Council Members Not in Attendance Dr. Jason Karlawish Mildred Morrison

PDA Staff in Attendance Teresa Osborne, Secretary Kellie Kask, Executive Assistant Terry Barley, Deputy Secretary Melissa Myers, Legislative Specialist Abdoul Barry, Legislative Director Kelly O’Donnell, Director of Operations & Management Abby Fox, Administrative Officer Chuck Quinnan, Council Executive Director Dr. David Galinsky, Chief Medical Officer Sasha Santana, Executive Secretary Neeka Jones, Chief Counsel Drew Wilburne, Communications Director

Guests in Attendance Shannon Baker, Department of Health Zach Shamberg, Pennsylvania Health Care Association Ed Beck, Department of Military & Veterans Affairs Timothy Ziegler, Capozzi Adler Sarah Copley, Greenlee Partners Andrew Zwally, Greenlee Partners Lauren Mishoe, Pennsylvania Homecare Association

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Meeting Minutes # Discussion Items Summary Secretary of Aging Teresa Osborne and Council Executive Director Chuck 1 Welcome Quinnan provided brief opening remarks and welcomed everyone to the meeting.

2 Introduction of Members & Members and guests introduced themselves and provided a brief description of Guests their long-term care background and experience. 3 Oath of Office for Governor’s Deputy Secretary of State Peter Speaks administered the oath of office to the Appointments Governor’s Council appointees, who had not yet taken the oath of office. 4 Pennsylvania Long-Term Care Representative , the prime sponsor of Act 64, discussed Council Act – Act 64 of 2015 the origin of the former Intra-Governmental Council on Long-Term Care and shared her vision for the new Council, noting the importance of ensuring that long-term care is person-centered, provided in an effective and efficient manner, and keeps the human component as a main focus. 5 Agency Long-Term Care Roles & The following individuals provided a brief overview of how their respective Functions agencies intersect with the long-term services and support system, including roles and responsibilities related to services for seniors and individuals with disabilities. PowerPoint presentations and handouts were provided.  DHS, Jennifer Burnett, Deputy Secretary of Long-Term Living  Health, Lori Gutierrez, Executive Policy Specialist  Insurance, Jessica Altman, Chief of Staff  DMVA, Edward Beck, Chief of Operations, Bureau of Veterans’ Homes  PennDOT, Emma Lowe, Special Assistant to the Secretary  PHFA, Gelene Nason, Manager of Housing Services  PDA, Secretary Teresa Osborne 6 Lunch

7 Council’s Charge Chuck Quinnan provided a synopsis of Act 64 and an overview of the Council’s (Act 64 & draft bylaws) draft bylaws. Members asked the following questions:

 Is a vice chair needed in the event the chair is not present? Response: Act 64 specifically names the Secretary of Aging as the chair of the Council. It does not give the chair the authority to appoint a designee.  What constitutes a simple majority? Response: A majority of the current Council membership, which is the same criteria as a quorum. It was noted that this could be further clarified in the bylaws.  Can the purpose section in the bylaws be amended? Response: Yes. Members need to provide Mr. Quinnan with their suggested changes prior to the next meeting. 8 Roundtable Discussion on Long- Secretary Osborne began the roundtable describing with the Council that several Term Care Priorities documents were given to her when she began her work with the Department as Acting Secretary, including the following: the Pennsylvania Long-Term Care Commission Report; the Pennsylvania State Plan for Alzheimer’s Disease and Related Disorders; and the Supreme Court’s Elder Law Task Force Report and Recommendations. In determining priorities, Secretary Osborne suggested that Council members review the recommendations contained in these reports. She specifically highlighted the four global recommendations of the Long-Term Care Commission Report, which are: 1) Improving care coordination in the LTSS System 2) Improving service Delivery in the LTSS System 3) Improving quality and outcomes in the LTSS System 2

4) Making the LTSS more fiscally sustainable It was also suggested that members review the Joint State Government Commission’s Report (Advisory Committee on Long-Term Care Services and Supports for Older Pennsylvanians) as well as the housing and barriers reports from the former Intra-Governmental Council on Long-Term Care. Secretary Osborne encouraged the Council members to remember that long-term care includes Pennsylvanians of all ages and stages of life, not just the elderly and asked members for their preliminary thoughts on what the focus of the Council should be based on their experiences and the agency presentations (see #5 above). Members’ comments largely focused on workforce needs and other barriers in providing access to quality long-term services and supports. The following is a summary of the specific issues and concerns that were raised, as well as suggestions: Workforce  Need to empower the workforce and address recruitment and retention/turnover of direct care workers o Find creative ways to attract young people and educate them about the positive attributes of the profession o Address compensation deficiency (e.g., living wage, paid time off, overtime, etc.) . Low pay is not commensurate with the high degree of caring required of these workers . Younger workforce (“millennials”) is interested in time off to care for personal matters, more so than previous generations o Remove red tape and engage workforce in the care they are providing, the mission . currently led by culture of discipline, not love  Addressing turnover is critical to continuity of care  Inadequate nursing home staffing levels o 2.5 hours of care is not sufficient  Cultural competency is a huge barrier to caring for the aging LGBT population. o Find ways to sensitize workers to this reality o Consider expanding AARP established workshops across the state  Invite students, schools, and caregivers to provide ideas to the Council on workforce sustainability Access to Home and Community-Based Services  Enrollment issues o Implement presumptive eligibility to reduce wait for home and community-based services (e.g., Aging Waiver)  The term rebalancing is concerning as it implies the system was previously balanced. o Need to determine proper split o Should look at other states (e.g., Oregon or Washington) to find out how they achieved 50/50 split and why they are now scaling back their efforts  DHS assisted living workgroup should explore extending the Aging Waiver to include assisted living  Evaluate nursing home transition programs Act 150  Must develop a model of how to fund the program and reduce the waiting time to receive services

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Alzheimer’s Disease and Related Dementias  In addition to the State Plan for Alzheimer’s Disease and Related Dementias, the Council should also review the “action steps” from the first forum. Council Committees  Creation of Council committees should take into account the unique needs of women and minorities Informal Caregiver Support  Encourage businesses to provide benefits (e.g., flextime, telecommuting, etc.) to allow employees to care for aging parents  Investigate adopting the United Way’s “United for Caregivers @ Work” initiative in other geographic areas throughout the commonwealth Nursing Home Complaints  A concern was raised regarding the Department of Health’s decision to reinstate anonymous nursing home complaints, while another member noted that such anonymity is important given the fear factor (e.g., fear of retaliation) involved with making a complaint. Intellectually Disability Community  Consider ways to better transition individuals born with intellectual disabilities as the system is greatly overburdened Long-Term Care Insurance  Educate consumers on planning alternatives for meeting financial consequences of long-term care (LTC)  Require insurance companies licensed to offer hybrid or linked products, including annuities with LTC riders, in Pennsylvania to also offer stand- alone, individual LTC policies  Require insurance producers who sell life, accident, and health insurance to complete the initial and ongoing training required by Section 39a.9 of Title 31 of the PA Code to qualify such producers to sell long-term care insurance  Develop a standardized educational program to teach producers the value and basic structure of a comprehensive LTC policy  Individual LTC policy premiums should be 100% deductible above the line for state and federal income tax purposes. LTSS Funding  Inadequate Medicaid rates  Monitor/react to potential financing changes at the federal level (e.g., Medicaid block grants) Overregulation  Need to get back to center and focus on basics  Avoid over fixing things  Look at past solutions and for simple solutions  Examine data to see how policy impacts peoples’ lives 9 Housekeeping PDA Chief Counsel Neeka Jones advised the Governor’s Council appointees (Governor’s Code of Conduct, 2017 that they must follow the Governor’s Code of Conduct and reviewed the ethical meeting dates & guidelines. travel/reimbursement process) Chuck Quinnan reviewed the Council’s 2017 meeting dates.

PDA Executive Assistant Kellie Kask reviewed the travel expense form, which is applicable to the Governor’s Council appointees.

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10 Open Session There were no public comments. 11 Adjournment The meeting was adjourned at 3:00 p.m.

New Action Items # Action Item Actionee(s) Deadline Status 1 Share long-term care reports (e.g., Long-Term Care Commission Chuck Quinnan ASAP Completed Report, Alzheimer’s State Plan, etc.) with Council members 2 Resolve meeting room configuration and audio issues Chuck Quinnan TBD In Progress 3 Synthesize feedback from roundtable discussion, develop post-meeting Sec. Osborne TBD Completed survey, and distribute to members for completion & Chuck Quinnan 4 Provide recommendation on Council committee structure and share Sec. Osborne TBD In Progress members feedback on priorities and committee structure based on & meeting and survey comments Chuck Quinnan 5 Who is not on the Council that should be asked to serve on a Council members TBD In Progress committee? 6 Changes to draft bylaws Chuck Quinnan, TBD In Progress Neeka Jones & Council members 7 Clarify federal rule regarding anonymous nursing home complaints Caitlin Palmer TBD In Progress Policy Director Dept. of Health

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